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The ACA MarketplaceS

Change in February effectuated enrollment, by state, 2025-2026

How Has ACA Marketplace Enrollment Changed Across States in 2026?

ACA Marketplace enrollment fell this year in every state except New Mexico, which was the only state to fully replace the enhanced premium tax credits that expired last year with a state-funded subsidy, according to a new KFF analysis of effectuated enrollment data. The Marketplace enrollment decline—the first in seven years—follows several years of rapid enrollment growth and coincides with the end of the enhanced federal subsidies.

How Much and Why ACA Marketplace Premiums Are Going Up in 2027

ACA Marketplaces insurers are proposing a median premium increase of 15% in 2027, according to KFF’s updated analysis of 276 insurers with publicly available filings across all 50 states and the District of Columbia. This is the second consecutive year of double-digit premium hikes. Last year’s median nationwide proposed rate change was 18%, and the median finalized rate change was 20%. While this proposed rate change is lower than last year, it represents the second-highest requested rate change since 2018, as premium growth had been relatively flat in this market for several years.

About the ACA

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Did the Affordable Care Act Make Health Care More Affordable?

The expiration of the ACA’s enhanced premium tax credits at the start of 2026, combined with rising insurer premiums, put a spotlight on health care affordability that extends beyond Marketplace enrollees. KFF’s Cynthia Cox examines the ACA’s record and the broader underlying question it raises: what’s a fair price for Americans people to pay for health care?

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  • I am having trouble setting up a Marketplace account online. The Marketplace website says that it cannot verify my identity. What should I do now?

    FAQs

    Some consumers with little or no credit history, such as young adults or recent immigrants, may have difficulty setting up accounts on HealthCare.gov. That is because the federal Marketplace uses real-time identity proofing techniques to protect consumers from unauthorized access to their personal information and to prevent fraud.  First, you should check to make sure you have entered all information requested in order to create an account, including information labeled as optional. If this does not…

  • How much are the cost-sharing reductions?

    FAQs

    It depends on your household income and where you live. To give a general idea, a typical Silver plan might have an annual out-of-pocket maximum on all cost sharing of $10,600 in 2026. But if your income is between 100% and 150% of the federal poverty level ($15,650 to $23,475 annually for a single individual in 2026), the cost-sharing reductions will modify a Silver plan so that the annual out-of-pocket maximum on all cost sharing…

  • I can’t afford to pay much for deductibles and co-pays. Is there help for me in the Marketplace for cost sharing?

    FAQs

    Yes. If your household income is between 100% and 250% of the federal poverty level ($15,650 to $39,125 annually for a single person in 2026, or $32,150 to $80,375 for a family of four), you can qualify for cost-sharing reductions if you choose a Silver plan. These will reduce the deductibles, copays, and other cost sharing that would otherwise apply to covered services.

  • I estimate my income next year will be very low, so I need my premium tax credit all paid in advance. If, by the end of the year, it turns out my annual income was even lower than I expected and I could...

    FAQs

    No, your final premium tax credit amount will be determined based on your income for the year as reported on your tax return. The fact that it ended up being less than you expected does not mean you have to repay the advance premium tax credit paid on your behalf, even if you could have qualified for Medicaid. In fact, your final credit amount will likely be larger than the amount you received in advance.…

  • Can I adjust the level of subsidy I collect in advance when my income goes up or down during the year? How often during the year can I make adjustments?

    FAQs

    You can make adjustments during the year whenever you need to. There is no limit to the number of times a person may report income, family, or insurance-eligibility changes to the Marketplace. Changes that you report will be verified by the Marketplace. Then the Marketplace will send you a notice (called a redetermination notice) showing your revised eligibility for premium tax credits and cost-sharing reductions. The adjustment should take effect by the first day of…

  • What is Form 8962?

    FAQs

    If you received an advanced premium tax credit (APTC) through the Marketplace last year, you must file a Form 8962 with your federal income tax return in order to "reconcile" your estimated and actual income for the year, even if you estimated your income perfectly. You can get a blank Form 8962 from the IRS website, or, if you use tax preparation software, the form will be automatically generated for you. The instructions for Form…

  • I received a Form 1095-C in the mail. What’s that?

    FAQs

    Form 1095-C will indicate your name and the name of your employer, the months when you were eligible for coverage, and the cost to you of the cheapest monthly premium you could have enrolled in under your employer’s health plan. If you worked for a large employer that did not offer its full-time employees health coverage, Form 1095-C will also indicate that. Keep this form with your tax records. You may need this form if…

  • I’ve picked the plan I want. What do I do next, and where do I send my premium payments?

    FAQs

    Your enrollment in the health plan is not complete until the insurance company receives your first premium payment. Once you’ve selected your plan, the Marketplace will direct you to your insurance company’s website to make the first premium payment. In most states, you will make your premium payments directly to the health insurance company. Insurance companies must accept different forms of payment, including for those who do not have a credit card or bank account.…